Basic Information
| Provider Information | |||||||||
| NPI: | 1982683900 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHRISTIANSEN | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1230 E MAIN ST | ||||||||
| Address2: | PO BOX 8674 | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560028674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1421 PREMIER DR | ||||||||
| Address2: | MANKATO CLINIC @ WICKERSHAM CAMPUS | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 07/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | 40897 | MN | N | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | 207Y00000X | 40897 | MN | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 29B05CH | 01 | MN | BCBS | OTHER | HP26577 | 01 | MN | HEALTH PARTNERS | OTHER | NA2951023820 | 01 | MN | PREFERRED ONE | OTHER | 040014402 | 01 | RR MEDICARE | OTHER | 41084933956001C131 | 01 | CHAMPUS | OTHER | 0593095 | 05 | IA | MEDICAID | 122979 | 01 | MN | UCARE | OTHER | 882297 | 01 | MN | AMERICAS PPO | OTHER | 1011816 | 01 | MN | MEDICA | OTHER | 153896900 | 05 | MN | MEDICAID |